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背景:注意缺陷多动障碍(Attention Deficit/Hyperactivity Disorder,ADHD)是中国精神科门诊儿童患者中最常见的诊断,最高比例约占所有患儿的50%。目的 :了解中国精神科儿童门诊ADHD患儿特征和治疗情况的变迁。方法 :随机抽取2000年至2011年间在上海市精神卫生中心儿少心理咨询门诊初诊患儿的病历,每年抽取250份。在所抽取的3000例患儿中,998例(33%)诊断为ADHD。结果 :约80%的ADHD患儿为男性,大多数在7岁之前患病。确诊患儿初诊时平均(标准差)年龄为10.0(2.6)岁,初诊时平均病程为2.9(1.2)年,近年趋势为初诊年龄变小,初诊时病程变短。约20%的患儿为非上海户籍,约11%合并其他精神疾病诊断(主要是抑郁症和抽动障碍),近年来上述比例呈上升趋势。576例(58%)有复诊记录的患儿中,77%接受中枢兴奋剂,但是,行为治疗(单用或合并药物)的比例近年来明显增加。结论 :ADHD仍然是中国精神科门诊儿童患者中最常见的诊断,但由于非专科治疗服务的扩大以及其他疾病诊断的增加,门诊ADHD患儿的比例在下降。令人欣慰的是ADHD呈现早诊断和早治疗的趋势以及非药物干预的应用有所增加。尽管如此,多数ADHD患儿确诊前至少已有2年病程,因此需要进一步研究来确定更好的方法以便更早地识别和治疗这一障碍。
Background: Attention Deficit / Hyperactivity Disorder (ADHD) is the most common diagnosis among pediatric psychiatric outpatients in China, with a maximum of about 50% of all children. OBJECTIVE: To understand the changes of characteristics and treatment of children with psychiatric pediatric ADHD. Methods: The records of children with newly diagnosed pediatric psychiatric counseling in Shanghai Mental Health Center from 2000 to 2011 were randomly selected and 250 cases were taken annually. Of the 3000 children drawn, 998 (33%) were diagnosed with ADHD. Results: About 80% of children with ADHD were men, most of whom were ill before the age of 7 years. The mean (standard deviation) age of the diagnosed children at the time of first visit was 10.0 (2.6) years. The average duration of the first visit was 2.9 (1.2) years. The trend in recent years was that the age at first visit became smaller and the duration of the first visit was shorter. About 20% of children with non-Shanghai household registration, about 11% with other mental disorders (mainly depression and tic disorder), in recent years the proportion of the upward trend. Of the 576 (58%) children with follow-up visits, 77% had central stimulants, but the proportion of behavioral therapy (single or combined) was significantly increased in recent years. CONCLUSIONS: ADHD remains the most common diagnosis among pediatric psychiatric outpatients in China, but the proportion of outpatient ADHD patients is declining due to an increase in non-specialist care services and increased diagnosis of other diseases. Fortunately, there is an increasing trend of early diagnosis and early treatment of ADHD as well as an increase in the use of non-drug interventions. However, most children with ADHD have had at least 2 years of disease prior to diagnosis, and further research is needed to identify better ways to identify and treat this disorder earlier.